Differences in outcomes between premenopausal women and men with gastric cancer in the United States.
Authors: Yi Lee, Hassan Aziz, Pin Li, Wei Zhao, Qasim Jehangir, Judie R. Goodman, Wasif M. Saif
Journal: Journal of Clinical Oncology (2022)

e16066 Background: Over the past decades, the incidence rate of gastric cancer has only dropped by 1.5% despite the identification of modifiable risk factors. Gastric cancer has a male predominance; the lower incidence in females may be associated with a protective hormonal effect. Studies reported the expression of estrogen receptor alpha (ERα) and beta (ERβ) in gastric cancer, yet their roles in incidence and prognosis remain inconclusive. We analyzed the hormonal association with the in-hospital outcomes using a cohort of premenopausal women and men with gastric cancer. Methods: Using Nationwide Inpatient Sample Database from 2016 to 2019, we selected adult women under age 51 as premenopausal as defined by the American College of Obstetricians and Gynecologists and compared to men of the same age group. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), thromboembolism, and gastrointestinal hemorrhage. Types of surgical interventions were also studied. Data were extracted using ICD-10 codes. Results: A total of 25,595 patients (based on a weighted sample) were included in the analysis; 44.6% were men, 7.5% were obese, and 13.7% were smokers. White race was most common (32.9% men vs 41.9% women), followed by Hispanic (34% vs 27.1%), African American (16.3% vs 16.1%), Asian (8.8% vs 7.7%), and Native American (1.3% vs 0.8%); p &lt; 0.05. The prevalence of common comorbidities was consistent among men and women; 29.5% had hypertension, 10.4% had diabetes mellitus, 2% had coronary artery disease, and 2.8% had congestive heart failure (CHF). Men had higher in-hospital mortality (7.9% vs 6%; p &lt; 0.05) and incidence of gastrointestinal hemorrhage compared to women (16.2% vs 9.7%; p &lt; 0.05). The median LOS was 5 days (IQR: 3-9) in men and 5 days (IQR: 2-9) in women; p = 0.59. The incidence of venous thromboembolism was 8.2% (no difference among sex) and myocardial infarction was 0.6% (0.8% men vs 0.2% women; p &lt; 0.05). Notably, in this younger population (age: 18-51), 63% patients had metastatic disease (62.8% men vs 63.4% women; p = 0.92). Among all patients, 27.8% underwent gastrectomy: partial gastrectomy (21.2%), total gastrectomy (4.9%), and robotic gastrectomy (1.7%). The multivariate logistic regression model adjusted for baseline demographics, comorbidities, metastatic disease, and socioeconomic status indicated that male sex (OR: 1.37; 95% CI: 1.07-1.73; p &lt; 0.05), Asian race (OR: 1.64; 95% CI: 1.09-2.46; p &lt; 0.05), CHF (OR: 4.05; 95% CI: 2.44-6.74; p &lt; 0.05), and metastasis (OR: 3.84; 95% CI: 2.73-5.37; p &lt; 0.05) were independent risk factors of in-hospital mortality. Conclusions: Our study shows that women have a lower incidence of gastric cancer and associated in-hospital mortality, which may support the protective role of estrogen. This highlights the need for translational and clinical studies on potential actionable mechanisms in gastric cancer management.